Department of Education Policy Studies, Penn State University, University Park, Pennsylvania, PA, United States; Population Research Institute, Penn State University, University Park, PA, United States.
Department of Education Policy Studies, Penn State University, University Park, Pennsylvania, PA, United States; Population Research Institute, Penn State University, University Park, PA, United States.
Psychiatry Res. 2023 Sep;327:115393. doi: 10.1016/j.psychres.2023.115393. Epub 2023 Aug 2.
We examined whether some groups of U.S. elementary schoolchildren are less likely to be diagnosed and treated for ADHD in analyses of a population-based cohort (N = 10,920). We predicted ADHD diagnosis using measures of race and ethnicity, age, socioeconomic status, birthweight, individually assessed academic, behavioral, and executive functioning, family language use, mental health, health insurance coverage, marital status, school composition, and geographic region. We predicted prescription medication use among those diagnosed with ADHD. We stratified additional analyses by biological sex. Black children (aOR, 0.60), girls (aOR, 0.55), and emergent bilinguals (aOR, 0.29) were less likely to have an ADHD diagnosis than observationally similar White children, boys, or those from English-speaking households. Black children's under-diagnosis occurred among boys. Emergent bilingual children's under-diagnosis occurred among both boys and girls. Girls (aOR, 0.52) and emergent bilinguals (aOR, 0.24) with ADHD were less likely to use prescription medication. Sociodemographic disparities in ADHD diagnosis and treatment occur among U.S. elementary schoolchildren. Measured confounds including independently assessed ADHD symptomatology and impairment do not explain the disparities. The findings empirically support cultural, linguistic, and biological sensitivity in the ADHD diagnostic and treatment procedures in use for the U.S. pediatric population.
我们通过对基于人群的队列（N=10920）进行分析，研究了美国一些小学生群体在 ADHD 诊断和治疗方面是否不太可能。我们使用种族和民族、年龄、社会经济地位、出生体重、个体评估的学业、行为和执行功能、家庭语言使用、心理健康、医疗保险覆盖范围、婚姻状况、学校组成和地理位置等指标预测 ADHD 诊断。我们预测了被诊断为 ADHD 的儿童中使用处方药物的情况。我们根据生物性别对额外的分析进行分层。与观察到的相似的白人儿童、男孩或来自英语家庭的儿童相比，黑人儿童（OR，0.60）、女孩（OR，0.55）和新兴双语者（OR，0.29）更不可能被诊断为 ADHD。黑人儿童的诊断不足发生在男孩中。新兴双语儿童的诊断不足发生在男孩和女孩中。患有 ADHD 的女孩（OR，0.52）和新兴双语者（OR，0.24）使用处方药物的可能性较低。美国小学生中存在 ADHD 诊断和治疗方面的社会人口差异。包括独立评估的 ADHD 症状和障碍在内的测量性混杂因素并不能解释这些差异。这些发现从实证上支持了美国儿科人群中 ADHD 诊断和治疗程序的文化、语言和生物学敏感性。
